多巴胺对体外循环下冠状动脉旁路移植术患者肝脏血流量的影响

目的:观察体外循环期间持续输注多巴胺对患者肝静脉血流动力学的影响?方法:选择20例择期行冠状动脉旁路移植术(CABG)患者,随机分成多巴胺组和对照组,多巴胺组在体外循环开始时泵注2 μg/(kg?min)多巴胺,分别于全麻诱导后(T0)?体外循环开始后5 min(T1)?体外循环后30 min(T2)及体外循环停机后30 min(T3),记录血流动力学变化(心率?血压等)及肝静脉血流相关指标(肝静脉直径?流速等)?比较术前与术后第1天肝肾功能的变化?结果:两组体外循环后血压均下降,多巴胺组停机后心率较对照组增快(P < 0.05);多巴胺组体外循环期间肝静脉血流量较术前有所上升(P < 0.05),但与对照组比较差异无统计学意义?与对照组相比,多巴胺组肌酐及尿素氮下降?结论:持续泵注2 μg/(kg?min)小剂量泵注多巴胺可能增加肝静脉血流,但仍需进一步研究合适的多巴胺剂量使其达到更好的临床效果?     

法舒地尔对体外循环二尖瓣置换术患者的心肌保护和肺保护作用

目的:观察法舒地尔对体外循环二尖瓣置换术患者的心肌保护和肺保护作用?方法:二尖瓣置换术患者40例,随机分为临床试验组(20例,法舒地尔1 mg/kg)和对照组(20例,等量生理盐水)?在麻醉后(T1)及体外循环后不同时间(T2~T5)测定血浆乳酸脱氢酶(lactate dehydrogenase,LDH)?肌酸激酶同工酶(creatine kinase-MB,CK-MB)?心肌肌钙蛋白Ⅰ(cardiac troponin Ⅰ,cTnⅠ)浓度,并监测动脉血气分析评价呼吸参数的变化?结果:体外循环后,临床试验组LDH?CK-MB?cTnI水平均比对照组低,差异有统计学意义(P < 0.05)?体外循环后对照组的血氧分压均低于临床试验组(P < 0.05),且氧合指数也明显低于同时点临床试验组水平(P < 0.05)?结论:对体外循环下二尖瓣置换术患者,法舒地尔可降低术后LDH?CK-MB?cTnI水平,减轻心肌缺血/再灌注损伤,改善氧合指数,具有心肌保护和肺保护作用?     

静脉注射地塞米松复合氟比洛芬酯有效减轻鼻内窥镜手术后疼痛

目的:观察术前静脉注射地塞米松复合氟比洛芬酯对鼻内窥镜手术(ESS)患者术后疼痛的影响?方法:90例全麻下行鼻内窥镜手术患者,随机分为地塞米松 + 氟比洛芬酯组(D组)?氟比洛芬酯组(F组)和生理盐水组(N组)各30例?全麻诱导气管插管后D组经静脉注射地塞米松10 mg和氟比洛芬酯50 mg,F组静脉注射氟比洛芬酯50 mg,N组静脉注射生理盐水4 ml?分别观察3组患者拔除气管导管后Ramsay镇静评分?术后2?6?12?24?48 h疼痛评分(VAS法)?舒适度评分(BCS评分)?观察术后不良反应及追加镇痛药及止吐药的用量?结果:D组术后12?24?48 h的VAS评分和BCS评分明显优于F组和N组,差异有统计学意义(P < 0.05)?D组术后不良反应发生率?镇痛药及止吐药追加量均低于F组和N组,差异有统计学意义(P < 0.05)?拔除气管导管后Ramsay镇静评分3组间差异无统计学意义(P > 0.05)?结论:地塞米松复合氟比洛芬酯术前使用可减轻鼻内窥镜手术后疼痛,减少镇痛药的使用及不良反应的发生?     

单中心双瓣置换应用Del-Nido停搏液与冷血停搏液心肌保护效果

目的回顾性分析昆明医科大学第一附属医院心脏大血管外科双瓣置换术中应用Del-Nido停搏液与冷血停搏液的心肌保护效果。方法选取2018年5月至2019年3月昆明医科大学第一附属医院心脏大血管外科心脏大血管外科132例双瓣置换手术患者,对比术中心脏自动复跳率、停机10 min平均动脉压(MAP)、停机10min中心静脉压(CVP)、术后使用多巴胺天数。132例患者分为AB两组,其中70例患者应用冷血停搏液,作为A组(男32例,女38例),62例患者应用Del-Nido停搏液作为B组(男26例,女36例。结果 A组患者12例自动复跳,复跳率17.1%; B组患者有20例自动复跳,复跳率32.2%,差异有统计学意义(P<0.05)。MAP(mm Hg):A组:(81.6±5.4),B组:(83.2±6.6),P=0.12;CVP (mm Hg):A组:(9.9±1.2),B组:(10.1±1.2),P=0.19;术后使用多巴胺(d):A组:(4.7±1.0),B组:(4.4±1.1),P=0.11。两组患者在停机10 min平均动脉压(MAP)、停机10 min中心静脉压(CVP)、术... 更多     

预注多巴胺与麻黄碱对老年患者全麻诱导后生命体征影响的比较

目的：研究多巴胺预防老年胃癌根治术患者全麻诱导时低血压的优势和剂量。方法60例气管插管全身麻醉接受胃癌根治术的老年患者,随机分为3组,D1组、D2组和C组,3组均采用相同药物行快速顺序诱导,在血压降低判定为低血压时,D1组给予1 mg多巴胺,D2组给予2 mg多巴胺,C组给予6 mg麻黄碱,分别记录MAP、CVP和HR的变化。结果诱导后即刻D2组的MAP和CVP最高,而心率介于D1和C组之间;插管后即刻D2组与C组的MAP和CVP最高,两组间差异无统计学意义（P＞0.05）,D2组HR介于D1组和C组之间;插管后5 min,D2组MAP和HR均介于D1组和C组之间。结论多巴胺单次静脉注射2 mg可以很好地维持老年患者全麻诱导期血压和心率的平稳,并且避免了心率持续过快,总体效果好于麻黄碱,这可能与多巴胺的正性肌力作用有关。     

参附注射液在冠脉搭桥术中的应用

目的 观察参附注射液用于冠脉搭桥术的患者全麻插管后体外循环各个阶段血流动力学的影响.方法 选择60例行冠脉搭桥术的患者随机均分为两组,参附组(30例)于麻醉诱导前静脉注射参附注射液0.5 mL/kg,对照组于麻醉诱导前静脉注射乳酸林格氏液0.5 mL/kg,5 min后麻醉诱导.全麻插管后立即行中心静脉(CVP),以及有创动脉(MAP)监测.记录插管后,体外循环各个时段有创动脉(MAP)、中心静脉(CVP)、HR,以及从并行辅助到复跳停机的时间.结果 参附组患者在术中血流动力学较为稳定且优于对照组,其复跳、停机时间短.结论 参附注射液可有效维持冠脉搭桥患者循环的稳定,缩短复跳、停机时间.     

围体外循环期应用小剂量多巴胺对肾脏的作用

目的:探讨围体外循环(CPB)期应用小剂量多巴胺对肾脏功能的影响.方法:选取48例无肾脏疾病行CPB心内直视手术的病人,将其随机分成两组,两组均采用静-吸全麻外,A组术始即以小剂量多巴胺持续泵注,余处理与B组相同.观察术前、术毕及术后24小时两组患者血尿素氮(BUN)、血肌酐(Cr)、尿蛋白及尿量等肾功能指标,了解肾损害情况.结果:应用小剂量多巴胺组与对照组的BUN、Cr、尿蛋白在术前、术毕及术后24小时比较差异均无统计学意义,而两组患者的尿量术毕及术后24小时差异有统计学意义,应用多巴胺组的尿量较对照组明显增加.结论:围体外循环期应用小剂量多巴胺对肾脏功能无保护作用.     

超声心动图评价室间隔缺损封堵术后心脏功能变化的随访研究

目的:应用经胸超声心动图评价室间隔缺损(VSD)封堵术后心脏结构?功能和血流动力学的变化,以评估疗效和术后恢复情况?方法:38例成功施行经皮穿刺VSD封堵术的患者术前?术后1周?1月及1年分别进行超声心动图检查,常规测量左心房内径(LAD)?左心室舒张末及收缩末内径(LVDd,LVDs)?左室射血分数(LVEF)?左室流出道血流速度(VLOVT)?二尖瓣口舒张期血流峰值速度(Em,Am);组织多普勒成像测量心室壁收缩期最大位移(Ds)?收缩期峰值速度(Vs)及二尖瓣环舒张早期及舒张晚期峰值速度(E’,A’),并计算E’/A’ ?Em/E’?结果:VSD封堵术后早期,LAD?LVDd?Ds较术前明显缩小,VLOVT明显加快(P均< 0.05),而LVEF?Vs无明显统计学差异(P > 0.05),受损升高的左心室舒张功能指标Em/E’有所下降,但尚无统计学意义(P > 0.05);术后1年,Em/E’下降至正常水平,VLOVT下降至术前水平(P均< 0.05),结论:经皮穿刺VSD封堵术早期可纠正VSD患者左心容量负荷过重导致的血流动力学紊乱和心脏结构异常;中期可改善受损的左室舒张功能;超声心动图对VSD封堵前后心脏功能变化的评估起了重要的作用?     

小剂量垂体后叶素治疗体外循环后血管麻痹综合征

目的 观察小剂量垂体后叶素在体外循环后血管麻痹综合征(VS)患者治疗中的作用及其并发症.方法 对24例体外循环后VS患者分别予以小剂量垂体后叶素(0.04 u·kg-1·h-1,A组)和去甲肾上腺素治疗(N组),治疗目标为达到平均动脉压(MAP)≥70 mm Hg,记录两组患者的性别、年龄、体质量、心功能分级、诊断、治疗前及治疗后(治疗后1、3、5、10、20、30、60、120 min)的血流动力学参数、尿量、肾功能、电解质、耗用去甲肾上腺素的剂量及病例数、临床并发症等.结果 予小剂量垂体后叶素治疗后1 min MAP和外周循环阻力指数(SVRI)均显著升高(P＜0.01),与N组患者相比,A组患者治疗后1 min的MAP升高显著(P＜0.01);在治疗后3 min的心指数(CI)显著降低(P＜0.01);中心静脉压(CVP)和平均肺动脉压(MPAP)无明显变化;每搏量变异(SVV)明显下降(P＜0.05).尿量显著增加(P＜0.05),血肌酐(Cr)显著下降(P＜0.05).结论 小剂量垂体后叶素治疗可明显改善体外循环后VS患者的血流动力学,并改善肾功能.     

右美托咪定复合舒芬太尼用于小儿骨科术后自控镇痛的效果观察

目的:观察右美托咪定复合舒芬太尼自控静脉镇痛在小儿骨科手术术后镇痛的效果及其安全性和有效性?方法:小儿骨科手术患者36例,ASAⅠ~Ⅱ级,随机分为舒芬太尼组(S组)和右美托咪定 + 舒芬太尼组(D组),每组18例?术后均给予自控静脉镇痛:S组为舒芬太尼2.0 ?滋g/kg +托烷司琼100 ?滋g/kg,D组为右美托咪定2.5 ?滋g/kg + 舒芬太尼2.0 ?滋g/kg + 托烷司琼100 ?滋g/kg,各组均加生理盐水至100 ml;负荷量均为舒芬太尼0.1 ?滋g/kg;背景剂量为2 ml/h,单次给药0.5 ml,锁定时间为15 min?观察两组患儿术后4?8?12?24?48 h的心率(HR)?平均动脉压(MAP)?呼吸频率(RR)?脉搏血氧饱和度(SpO2)?视觉模拟评分(VAS)?Ramsay改良评分?不良反应发生率及8 h后开始功能锻炼时的VAS评分?结果:术后各时点MAP?HR?RR及SpO2各组间差异无统计学意义 (P > 0.05)?安静时两组术后4?8?12?24?48 h的VAS评分无统计学差异(P > 0. 05),功能锻练时D组术后8?12?24?48 h的VAS评分优于S组,差异有统计学意义(P < 0. 05)?Ramsay改良评分4 h时D组满意率大于S组,差异有统计学意义(P < 0. 05)?两组术后恶心呕吐?皮肤瘙痒等不良反应都比较低,差异无统计学意义(P > 0.05)?结论:右美托咪定复合舒芬太尼用于小儿骨科术后自控静脉镇痛效果确切,有利于术后早期的功能锻炼,安全可靠?不良反应少,值得在临床上推广?     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.     

Development Is A High Level Inheritance for China Time-honored Brand Products

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